^(18)FDG-PET/CT对评价TACE联合RFA治疗原发性肝癌的效果的价值

Evaluating Efficacy of Transcatheter Arterial Chemo-embolization Combined with Radiofrequency Ablation on Patients with Hepatocellular Carcinoma by ^(18)FDG-PET/CT

背景与目的:原发性肝癌经动脉导管栓塞化疗(transcatheterarterialchemo-embolization,TACE)联合射频消融(radiofrequencyablation,RFA)治疗后,CT扫描对判断是否有肿瘤残留存在一定的困难,而18FDG-PET/CT(18-fluorodeoxyglucose-positronemissiontomograply/CT)在判断肿瘤残留上具有优势。本研究对13例原发性肝癌经TACE联合RFA治疗周后,采用CT和18FDG-PET/CT检查是否存在肿瘤残留,分析CT和18FDG-PET/CT在判断肿瘤残留上的差异,并根据18FDG-PET/CT的结果指导肿瘤治疗。方法:本组13例原发性肝癌患者共有18个病变,肿瘤最长直径为0.8～16.0cm。12例为初治病例;1例为肝癌手术后复发,肝内共发现有3个病变。经过TACE联合RFA治疗后2～3周,对比CT和18FDG-PET/CT检查的结果;如发现有肿瘤残留,在2～3周内对其进一步行RFA治疗。结果:13例患者经一次TACE联合一次RFA治疗2～3周,经病变区域活检及数字减影血管造影等检查发现11例有部分肿瘤残留,肿瘤残留最长直径为1.0～2.1cm;CT增强扫描检查检出5例,18FDG-PET/CT检出有10例残留,CT与18FDG-PET/CT检出率分别为45.4%及90.9%。根据检查结果,在2～3周内经过第二次RFA治疗后,18FDG-PET/CT检查发现10例患者肿瘤无残留,另1例6周后复查18FDG-PET/CT发现肝内病变未控,患者带瘤生存。结论:原发性肝癌经TACE联合RFA治疗以及手术后,18FDG-PET/CT对判断肿瘤残留以及根据检查结果指导RFA治疗较CT检查具有更大的优势。

BACKGROUND ＆ OBJECTIVE： Judging tumor residue of hepatocellular carcinoma （HCC） after treatment of transcatheter arterial chemo-embolization （TACE） combined with radiofrequency ablation （RFA） by computed tomography （CT） scan is difficult; while 18-fluorodeoxyglucose- positron emission tomography/CT （^18SFDG-PET/CT） has some advantages in this aspect. This study was designed to compare the results of ^18FDG-PET/CT and CT scan in judging tumor residue of HCC after treatment of TACE combined with RFA, and to guide following treatment according to the result of ^18FDG-PET/CT. METHODS： Thirteen HCC patients with 18 lesions, 0.8- 16.0 cm in diameter, were treated in Cancer Center of Sun Yat-sen University from Nov. 2002 to Jun. 2003. Of the 13 patients, 12 were naive patients with 15 lesions; 1 was relapsed with 3 lesions 1 year after hepatectomy. The results of CT and ^18FDG-PET/CT of the 13 patients 2-3 weeks after treatment of TACE combined with RFA were compared. If tumor residue was dictated, a further RFA treatment would be applied within 2-3 weeks. RESULTS： Of the 13 HCC patients that received 1 course of TACE combined with RFA, 11 had tumor residues which were conformed by fine needle biopsy and digital substraction angiography （DSA）. CT only detected 5 positive cases; however, ^18SFDG-PET/CT detected 10 positive cases. Positive rate of CT was 45.4%, and that of ^18SFDG-PET/CT was 90.9%, According to the results of ^18SFDG-PET/CT of the 11 patients, after the second course of RFA, 10 patients had no tumor residue; 1 patient survived with uncontrolled lesion 6 weeks after treatment. CONCLUSION; ^18SFDG-PET/CT is better than CT in judging tumor residue of HCC after treatment of TACE combined with RFA or surgery, and in guiding further treatment of HCC.